PHLEBOTOMY LECTURE

PREPARED BY:
Isaiah John B. Fancubit, RMT, MLS (ASCPi)
WHAT IS PHLEBOTOMY?

• Phlebotomy is the act of

drawing or removing blood
from the circulatory system
through a cut (incision) or
puncture in order to obtain
a sample for analysis and
diagnosis. Phlebotomy is
also done as part of the
patient’s treatment for
certain blood disorders.
BRIEF HISTORY

• Phlebotomy was known as bloodletting when it was first

used and dates back to the ancient Egyptians, around
1000 BC. They believed that the process of releasing
blood from the body would cure various diseases, such as
the plague and acne. Some even believed that it could
cast out evil spirits. In this case, the procedure would be
performed by a priest, who was also the official
“physician” during that time.
• As time moved on, bloodletting
became quite a common practice
throughout Europe, and it was
believed that the disease left your
system along with the blood. The
reality was that it simply spread the
infection to everyone else. Pre-
nineteenth century, blood was
simply thought to be something that
caused lots of the conditions
associated with sickness and
ailments. Often, people would have
leeches placed onto their skin to
“rid” them of the disease they were
suffering from.
ORDER OF DRAW
ORDER OF DRAW
ORDER OF DRAW
PRECURSOR TO PERFORMING PHLEBOTOMY

Using an appropriate location

The phlebotomist should work in a quiet, clean, well-lit area,
whether working with outpatients or inpatients.
Availability of appropriate supplies and
protective equipment
Management should provide hand-hygiene materials (soap and
water or alcohol rub), well-fitting non-sterile gloves, single-use
disposable needles, and syringes or lancing devices in sufficient
numbers to ensure that each patient has a sterile needle and
syringe or equivalent for each blood sampling.
STEPS IN PHLEBOTOMY
STEP 1: Assemble equipment
Step 2. Identify and prepare the patient
• Introduce yourself to the patient, and ask the patient to state
their full name.
• Check that the laboratory form matches the patient's identity
(i.e. match the patient's details with the laboratory form, to
ensure accurate identification).
• Ask whether the patent has allergies, phobias or has ever
fainted during previous injections or blood draws.
• If the patient is anxious or afraid, reassure the person and
ask what would make them more comfortable.
• Make the patient comfortable in a supine position (if
possible).
• Place a clean paper or towel under the patient's arm.
Step 3. Select the site
• Extend the patient's arm and inspect the
antecubital fossa or forearm.
• Locate a vein of a good size that is visible,
straight and clear. The median cubital vein lies
between muscles and is usually the most easy
to puncture. Under the basilic vein runs an
artery and a nerve, so puncturing here runs the
risk of damaging the nerve or artery and is
usually more painful. DO NOT insert the needle
where veins are diverting, because this
increases the chance of a haematoma.
• The vein should be visible without applying the
tourniquet. Locating the vein will help in
determining the correct size of needle.
• Apply the tourniquet about 4–5 finger widths
above the venepuncture site and re-examine
the vein.
Step 4. Perform hand hygiene and put on gloves
• Perform hand hygiene; that is
• wash hands with soap and water,
and dry with single-use towels; or
• if hands are not visibly
contaminated, clean with alcohol
rub – use 3 ml of alcohol rub on the
palm of the hand, and rub it into
fingertips, back of hands and all
over the hands until dry.
• After performing hand hygiene, put
on well-fitting, non-sterile gloves.
Step 5. Disinfect the entry site
• Unless drawing blood cultures, or prepping for a blood collection, clean the
site with a 70% alcohol swab for 30 seconds and allow to dry completely (30
seconds)
• Note: alcohol is preferable to povidone iodine, because blood contaminated
with povidone iodine may falsely increase levels of potassium, phosphorus
or uric acid in laboratory test results (6, 7).
• Apply firm but gentle pressure. Start from the centre of the venipuncture site
and work downward and outwards to cover an area of 2 cm or more.
• Allow the area to dry. Failure to allow enough contact time increases the risk
of contamination.
• DO NOT touch the cleaned site; in particular, DO NOT place a finger over
the vein to guide the shaft of the exposed needle. It the site is touched,
repeat the disinfection.
Step 6. Take blood
• Anchor the vein by holding the patient's arm and placing a thumb BELOW the
venepuncture site.
• Ask the patient to form a fist so the veins are more prominent.
• Enter the vein swiftly at a 30 degree angle or less, and continue to introduce
the needle along the vein at the easiest angle of entry.
• Once sufficient blood has been collected, release the tourniquet BEFORE
withdrawing the needle. Some guidelines suggest removing the tourniquet as
soon as blood flow is established, and always before it has been in place for
two minutes or more.
• Withdraw the needle gently and apply gentle pressure to the site with a clean
gauze or dry cotton-wool ball. Ask the patient to hold the gauze or cotton
wool in place, with the arm extended and raised. Ask the patient NOT to bend
the arm, because doing so causes a haematoma.
Step 7. Fill the laboratory sample tubes

• When obtaining multiple tubes of blood, use evacuated

tubes with a needle and tube holder. This system allows
the tubes to be filled directly. If this system is not
available, use a syringe or winged needle set instead.
• If a syringe or winged needle set is used, best practice is
to place the tube into a rack before filling the tube. To
prevent needle-sticks, use one hand to fill the tube or use
a needle shield between the needle and the hand holding
the tube.
Step 8. Draw samples in the correct order

REFER TO ORDER OF
DRAW
Step 9. CLEAN YOUR AREA
 CHECKLIST FOR PRACTICAL EXAM
• Assemble equipment. (gloves, alcohol pad, cotton, syringe, tourniquet, plaster, tubes)
• Identify and prepare the patient. (introduce your name, ask the patient's name, ask the
patient how he or she is feeling)
• Select the site. (1st median, 2nd cephalic, 3rd basilic)
• Perform hand hygiene and put on gloves. (proper handwashing technique)
• Disinfect the entry site. (inner to outer circle motion)
• Let the alcohol dry.
• Take blood. (15-30 degrees, bevel up, smooth motion of draw)
• Cap the needle using 1-hand technique.
• Fill the laboratory sample tubes. (fill the correct volume required and the # of inversions
required.)
• Draw samples in the correct order. (Yellow - SPS, Blue, Red or Yellow – clot activator,
Green, Lavender, Gray)
RETURN DEMONSTRATION